Transvenous Phrenic Nerve Stimulation and Automatic Positive Airway Pressure Therapy for Treating Central Sleep Apnea and Residual Obstructive Sleep Apnea

Abstract

Central sleep apnea (CSA) is a neurological breathing disorder resulting from intermittent disruptions in the neural drive to breath. CSA and obstructive sleep apnea (OSA), caused by partial or complete airway blockage, sometimes occur together. The remede System (Respicardia, Minnetonka, MN) is an implantable device that delivers transvenous phrenic nerve stimulation therapy (TPNS) to treat CSA. A patient who failed previous Positive Airway Pressure (PAP) therapies presented with severe CSA and OSA with a baseline Apnea Hypopnea Index (AHI) of 98.1 events/hour. The patient was implanted with a TPNS device and titrated to maximum effectiveness. His CSA improved, but still had persistent OSA. PAP therapy was added to supplement the TPNS. With TPNS off, PAP therapy treated obstructive events but not the central events. TPNS alone treated the central events but not the obstructive events. With both therapies on, CSA and OSA were controlled and breathing was normalized (AHI=3.8). ClinicalTrials.gov Identifier: NCT01816776.